TB beyond the numbers: Community, Rights and Gender (CRG) and Stigma assessments matter for ending TB

Nestled in the Eastern Himalayas between India and China, Bhutan is a small lower-middle-income country with a population of around 800,000 people, known for its commitment to Gross National Happiness (GNH), environmental conservation, and universal access to health services. Despite notable progress in health and development, tuberculosis (TB) remains a significant public health challenge in the country. Bhutan has an estimated TB incidence of approximately 190 cases per 100,000 population in 2024 and around 800 to 1,300 people developing TB each year. Based on the GNH index approach, comprehensive wellbeing of the Bhutanese population is a key priority of policymakers in the country. Therefore, understanding and addressing social and structural barriers to TB care is essential to building people-centred, effective, and equitable TB programmes.

Placing a focus on Community, Rights and Gender (CRG) provides an important opportunity in Bhutan to:

• identify barriers to TB care,
• amplify the voices of communities affected by TB,
• and strengthen local efforts towards a more equitable, people-centred TB response.

Earlier this year, KNCV Tuberculosis Foundation was commissioned to support in a hybrid tuberculosis programme review in Bhutan, with a specific focus on their Community, Rights and Gender (CRG) and TB stigma reduction approaches.

But, what does Community, Rights and Gender (CRG) and Stigma Reduction mean for in TB care and prevention?

In TB programming, CRG is an approach that recognizes that TB is not only a medical condition but also a social issue. Widely promoted by global partners such as the Global Fund, CRG seeks to ensure that local TB responses are designed around the needs and experiences of people affected by the disease.

TB-related stigma remains one of the most significant barriers to ending the TB epidemic. It influences how people affected by TB seek care, delay diagnosis, compromise treatment adherence, and negatively impact quality of life.

Stigma occurs at multiple levels, including within healthcare systems, communities, families, health facilities, workplaces and even within individuals themselves through self-stigma. KNCV approaches to stigma reduction recognize that it requires interventions that address attitudes, behaviours and systems across all of these levels.

Why countries need CRG and Stigma assessments?

Many TB programs have limited information on the social, gender-related and human rights barriers that affect access to services. CRG and stigma assessments provide data that helps programmes move beyond assumptions and better understand the realities faced by affected communities.

These assessments can help countries:

• Identify populations that experience barriers to accessing TB care services;
• Understand where and how stigma occurs, i.e. system level, community level, individual level;
• Explore gender-related challenges that influence timely diagnosis and treatment;
• Assess the level of community engagement in TB responses;
• Identify human rights concerns, including discrimination and inequities in access to care;
• Generate evidence to inform policies, program design, resource allocation and targeted interventions.

Supporting communities, protecting human rights, promoting gender equity and reducing TB-related stigma are fundamental building blocks of a comprehensive and sustainable response to TB.

For more information contact us at stigmareduction@kncvtbc.org and revie